Journal of thoracic disease最新文献

{"title":"Efficacy and safety of glycopyrrolate/formoterol fumarate metered dose inhaler in patients with tuberculosis-associated chronic obstructive pulmonary disease: study protocol for a randomised controlled trial.","authors":"Fan Wu, Suyin Huang, Ming Lei, Zhishan Deng, Qi Wan, Gaoying Tang, Kunning Zhou, Xiaoyan Liang, Tuxunguli Abduwaiti, Reyihanguli Turgon, Kaiqing Zhang, Kailibinur Turgon, Yanni Li, Haiqing Li, Weifeng Zou","doi":"10.21037/jtd-2025-aw-2264","DOIUrl":"https://doi.org/10.21037/jtd-2025-aw-2264","url":null,"abstract":"<p><strong>Background: </strong>Clinical trials have shown that glycopyrrolate/formoterol fumarate improves lung function in patients with chronic obstructive pulmonary disease (COPD) caused by tobacco exposure. Although tuberculosis-associated COPD has worse respiratory health outcomes than smoking-associated COPD, no clinical trials have determined whether pharmacological intervention is effective. We designed a clinical trial to evaluate the safety and efficacy of glycopyrrolate/formoterol fumarate for the treatment of tuberculosis-associated COPD.</p><p><strong>Methods: </strong>We report the protocol for a prospective, multicentre, open-label, parallel-group, observer-blind, randomised clinical trial in China. Tuberculosis-associated COPD will be defined as a history of pulmonary tuberculosis and imaging manifestations, no current long-term anti-tuberculosis treatment, smoking index <10 pack-years, postbronchodilator forced expiratory volume in 1 second (FEV₁)/forced vital capacity (FVC) ratio <0.70, and FEV₁ ≥50% predicted. Patients with tuberculosis-associated COPD will be randomly assigned (1:1) to the glycopyrrolate/formoterol fumarate metered dose inhaler (18 µg/9.6 µg twice daily) or no additional treatment. All patients will be provided with salbutamol as rescue medication. The primary outcome will be the between-group difference in the change from baseline to 12 weeks in prebronchodilator FEV₁. The key secondary outcomes will be the between-group difference in the change from baseline to 12 weeks in postbronchodilator FEV₁; percentage predicted prebronchodilator and postbronchodilator FEV₁, FVC, and percentage predicted FVC; and COPD Assessment Test scores.</p><p><strong>Discussion: </strong>The results of the PTB-COPD trial will provide the first insights into the pharmacological treatment of tuberculosis-associated COPD. We anticipate the results of this trial to be available in the first half of 2027.</p><p><strong>Trial registration: </strong>Chinese Clinical Trial Registry, ChiCTR2500103088. Registered on May 23, 2025.</p>","PeriodicalId":17542,"journal":{"name":"Journal of thoracic disease","volume":"18 3","pages":"256"},"PeriodicalIF":1.9,"publicationDate":"2026-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13077358/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147690869","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"CT-guided coaxial four-hook localization improves precision and efficiency in video-assisted thoracoscopic surgery: a retrospective study.","authors":"Xiaoya Chen, Jing Li, Haoming Guo, Runtian Cheng, Yongliang Han, Fengming Tao, Mengqi Liu, Haitao Yang, Xinghua Li, Zubin Ouyang","doi":"10.21037/jtd-2025-1-2447","DOIUrl":"https://doi.org/10.21037/jtd-2025-1-2447","url":null,"abstract":"<p><strong>Background: </strong>With the increasing detection of small and indeterminate pulmonary nodules in the era of low-dose computed tomography (CT) screening, accurate preoperative localization has become critical for successful video-assisted thoracoscopic surgery (VATS), particularly for non-palpable lesions. This study aimed to evaluate and compare the effectiveness and complication profiles of 3D image reconstruction and a novel CT-guided coaxial four-hook localization system.</p><p><strong>Methods: </strong>This retrospective study included patients who underwent VATS for pulmonary nodules, guided by either 3D image reconstruction (n=273 nodules) or CT-guided coaxial four-hook localization (n=255 nodules). Clinical and imaging variables were compared, including nodule characteristics, surgical approach, operative time, hospital stay, and complication rates. Multivariate logistic regression was performed to identify independent risk factors for procedure-related complications.</p><p><strong>Results: </strong>Both the 3D image reconstruction group and CT-guided localization group achieved high localization success rates (98.5% <i>vs.</i> 99.6%). Compared to the 3D image reconstruction group, patients in the CT-guided localization group had significantly smaller nodules, a higher proportion of pure ground-glass nodules, and shorter pleural distances (all P<0.001). In subgroups with benign lesions, adenocarcinoma <i>in situ</i>, and minimally invasive adenocarcinoma, the CT-guided localization group showed a higher rate of wedge resections and significantly shorter operative times (all P<0.05). Although the CT-guided localization group exhibited a higher overall complication rate, primarily pneumothorax, most events were mild and self-limited. Multivariate analysis identified greater needle depth as an independent risk factor for pulmonary hemorrhage in the CT-guided localization group (P<0.01).</p><p><strong>Conclusions: </strong>Both 3D image reconstruction and CT-guided localization are safe and effective for preoperative guidance in VATS. The CT-guided method provides superior intraoperative precision and efficiency, particularly in managing small, pure ground-glass nodules and in cases requiring function-preserving wedge resections.</p>","PeriodicalId":17542,"journal":{"name":"Journal of thoracic disease","volume":"18 3","pages":"203"},"PeriodicalIF":1.9,"publicationDate":"2026-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13077374/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147690871","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparative analysis of short-term outcomes, inflammatory markers, and complications in robotic-assisted <i>vs.</i> traditional thoracoscopic surgery for complex pulmonary segmentectomy.","authors":"Yuhao Xu, Xuefeng Wang, Biao Deng, Zhu Liang, Zhigang Wang","doi":"10.21037/jtd-2025-aw-2146","DOIUrl":"https://doi.org/10.21037/jtd-2025-aw-2146","url":null,"abstract":"<p><strong>Background: </strong>Robotic-assisted thoracic surgery (RATS) and video-assisted thoracic surgery (VATS) have been utilized in the context of complex pulmonary segmentectomy. However, the extant literature offers a paucity of information with regard to the early outcomes and inflammatory impacts of these approaches inadequately. We analyzed perioperative outcomes, inflammatory markers, and complications in 31 RATS and 66 VATS cases.</p><p><strong>Methods: </strong>A retrospective study was conducted on 97 patients undergoing complex pulmonary segmentectomy for pulmonary nodules at The Affiliated Hospital of Guangdong Medical University between July 2022 and October 2024. Short-term surgical outcomes and inflammatory markers were compared.</p><p><strong>Results: </strong>Among 97 patients with comparable baseline characteristics, no significant differences were observed in intraoperative blood loss, extubation time, or overall complication rates between RATS (n=31) and VATS (n=66). However, RATS demonstrated shorter operative time (174.00±50.67 <i>vs.</i> 224.24±61.65 min, P<0.001), reduced inflammatory responses [postoperative white blood cell counts: (9.90±2.10)×10⁹/L <i>vs.</i> (13.31±4.03)×10⁹/L, P<0.001], and fewer dissected lymph nodes (7.60±4.79 <i>vs.</i> 12.48±7.80, P=0.002). RATS also exhibited superior ergonomic design and three-dimensional (3D) visualization.</p><p><strong>Conclusions: </strong>For patients diagnosed with early-stage pulmonary nodules, RATS significantly shortens operative time, mitigates inflammatory responses, and enhances ergonomic efficiency compared to VATS.</p>","PeriodicalId":17542,"journal":{"name":"Journal of thoracic disease","volume":"18 3","pages":"222"},"PeriodicalIF":1.9,"publicationDate":"2026-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13077380/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147690893","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Assessment of susceptibility to mTOR rs2295080 gene polymorphism in Guangxi Zhuang lung cancer population.","authors":"Dongli Yang, Chao Zuo, Jing Cheng, Yi Liu, Yu Wang, Yongchao Qiao","doi":"10.21037/jtd-2025-aw-2375","DOIUrl":"https://doi.org/10.21037/jtd-2025-aw-2375","url":null,"abstract":"<p><strong>Background: </strong>Lung cancer is a leading cause of cancer-related deaths globally. While single-nucleotide polymorphisms (SNPs) are established genetic modulators of cancer susceptibility, the specific functions of SNPs in the mammalian target of rapamycin (mTOR) pathway in lung cancer pathogenesis remain largely unclear. This study investigated the associations between a specific SNP in the promoter region of the mTOR gene, the corresponding mTOR protein expression levels, and lung cancer susceptibility in the study population.</p><p><strong>Methods: </strong>Genotyping of 136 healthy controls and 241 lung cancer patients was performed using SNP scanning high-throughput technology. Lung cancer patients were further classified into lung squamous cell carcinoma (LUSC), lung adenocarcinoma (LUAD), and small cell lung cancer (SCLC). Logistic regression, independent samples <i>t</i>-test, and Chi-squared test were used for susceptibility and difference analysis. Protein expression differences were analyzed using the Clinical Proteomics Tumor Analysis Consortium (CPTAC) database and immunohistochemistry (IHC).</p><p><strong>Results: </strong>The results showed that mTOR-rs2295080 was significantly associated with the risk of developing LUAD and SCLC. The GT genotype reduced the risk of LUAD compared with the TT genotype [odds ratio (OR) =0.513; 95% confidence interval (CI): 0.300-0.877; P=0.02]. The G allele reduced the risk of SCLC compared to the T allele (OR =0.377; 95% CI: 0.185-0.769; P=0.007). IHC results according to genotype and pathology type showed that rs2295080-GT had the lowest protein expression levels of MTOR in tumor tissues of LUAD and LUSC patients compared to those of GG and TT.</p><p><strong>Conclusions: </strong>The mTOR rs2295080 polymorphism is associated with a reduced risk of lung cancer and may exert a protective effect by reducing protein expression.</p>","PeriodicalId":17542,"journal":{"name":"Journal of thoracic disease","volume":"18 3","pages":"189"},"PeriodicalIF":1.9,"publicationDate":"2026-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13077243/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147690230","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Inflammatory memory: the core mechanism driving allergic asthma recurrence and chronicity.","authors":"Xu Liu, Ming Zhu, Qianyue Jing, Man Jia, Xin Yao","doi":"10.21037/jtd-2025-1-2491","DOIUrl":"https://doi.org/10.21037/jtd-2025-1-2491","url":null,"abstract":"<p><p>Advances in biomarker discovery, inhalation therapy, biologics, and bronchial thermoplasty have significantly improved the clinical prognosis and symptom control in patients with asthma. However, recurrence and chronicity of the disease after treatment withdrawal is still a core challenge in clinical management. The emerging concept of inflammatory memory has provided a new perspective for understanding the recurrent remission-relapse cycle in asthma. During asthma onset and development, immune cells and airway structural cells acquire persistent pathogenic memory traits through epigenetic and metabolic reprogramming, thereby amplifying the efficacy of allergen recognition and presentation resulting in local memory niches. These reduce the threshold for airway responses and mediate irreversible airway structural remodeling. In addition, infection, as a key environmental factor, modulates both asthma susceptibility and severity through cross-antigen activation, immune skewing and epigenetic training. Evidence from animal studies suggests that current therapies (especially biological agents) may have the potential to modulate long-resident pathogenic memory immune cells by targeting key cells and inflammatory pathways. However, there are still clinical challenges in the application from animal models to asthma patients. Future interventions should focus on targeting the formation, maintenance, and reactivation of inflammatory memory to attenuate the potential pathogenic memory program in asthma. In this review, we systematically discuss the multi-layered mechanisms of inflammatory memory in asthma pathogenesis, emphasizing the importance of exploring novel strategies for inflammatory memory intervention toward achieving long-term remission.</p>","PeriodicalId":17542,"journal":{"name":"Journal of thoracic disease","volume":"18 3","pages":"252"},"PeriodicalIF":1.9,"publicationDate":"2026-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13077430/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147690304","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"IMpower151: is this the final blow to PD-(L)1 inhibitors in metastatic, <i>EGFR</i>-mutant non-small-cell lung cancer?","authors":"Salomé A L van Beusekom, Michiel M Smeenk, Adrianus J de Langen","doi":"10.21037/jtd-2025-aw-2337","DOIUrl":"https://doi.org/10.21037/jtd-2025-aw-2337","url":null,"abstract":"","PeriodicalId":17542,"journal":{"name":"Journal of thoracic disease","volume":"18 3","pages":"262"},"PeriodicalIF":1.9,"publicationDate":"2026-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13077386/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147690320","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Intercostal nerve blocks take the lead: rethinking regional analgesia for video-assisted thoracic surgery.","authors":"Juan F Villa, Hart Donahue, Ravi Rajaram, Juan P Cata","doi":"10.21037/jtd-2026-1-0062","DOIUrl":"https://doi.org/10.21037/jtd-2026-1-0062","url":null,"abstract":"","PeriodicalId":17542,"journal":{"name":"Journal of thoracic disease","volume":"18 3","pages":"259"},"PeriodicalIF":1.9,"publicationDate":"2026-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13077347/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147690562","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical characteristics and survival analysis of non-smoking small cell lung cancer.","authors":"Shuang Li, Yansu Wang, Yang Liu, Shuang Zhang","doi":"10.21037/jtd-2025-1-2594","DOIUrl":"https://doi.org/10.21037/jtd-2025-1-2594","url":null,"abstract":"<p><strong>Background: </strong>Despite the general belief that smoking is the primary cause of small cell lung cancer (SCLC), a significant number of SCLC cases do not have a history of smoking. Research on the clinical characteristics and prognosis of non-smoking SCLC is essential. This study aimed to analysis of the clinical characteristics, prognosis, and the impact of treatment changes on survival of patients with non-smoking SCLC.</p><p><strong>Methods: </strong>We conducted a retrospective analysis of non-smoking SCLC at a single cancer center from January 1, 2013, to March 31, 2025. Descriptive statistics were used to summarize the baseline characteristics of the study population. The Kaplan-Meier method was used for survival analysis. Differences in survival distributions between these groups were compared using the log-rank test.</p><p><strong>Results: </strong>A total of 1,607 patients were non-smokers, with a higher proportion of females (58.6%). The median age was 59 years. Among them, 980 patients had limited-stage SCLC (LS-SCLC). For LS-SCLC, the median overall survival (OS) was 34.27 months [95% confidence interval (CI): 30.17-38.37 months], while it was 18.37 months (95% CI: 16.76-19.78 months) for extensive-stage SCLC (ES-SCLC). The OS of LS-SCLC patients between the two periods varied significantly according to a temporal trend analysis, stratified by 2019 (P<0.001). The median OS of patients with ES-SCLC diagnosed after 2019 was significantly improved compared to that of patients diagnosed before 2019 (P=0.004).</p><p><strong>Conclusions: </strong>A distinct subgroup of SCLC with unique characteristics is non-smoking SCLC. The prognosis for patients with non-smoking SCLC is also improving due to treatment advancements.</p>","PeriodicalId":17542,"journal":{"name":"Journal of thoracic disease","volume":"18 3","pages":"211"},"PeriodicalIF":1.9,"publicationDate":"2026-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13077373/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147690724","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The impact of best practice meetings on clinical outcomes in surgical and oncological care: a scoping review.","authors":"Janne van den Hurk, Felix Hers, Lars van de Sanden, Barend M E Mees, Grard A P Nieuwenhuijzen, Mark M J Nielen, Rob H A Verhoeven, Misha D P Luyer, Bas P L van Wijnhoven, Michel W J M Wouters","doi":"10.21037/jtd-2025-aw-2097","DOIUrl":"https://doi.org/10.21037/jtd-2025-aw-2097","url":null,"abstract":"<p><strong>Background: </strong>Best practice meetings (BPMs) serve as collaborative forums where peer clinicians systematically review inter-institutional data, including treatment characteristics, clinical processes, and survival outcomes. The goal is to identify inter-hospital variation and facilitate mutual learning to improve the quality of care. Despite centralization of surgical and oncological care and implementation of volume thresholds, inter-hospital outcome variation persists. Additional instruments, such as BPMs, are necessary to help drive quality improvement (QI), but the effectiveness remains uncertain. This scoping review aims to evaluate the effect of BPMs on clinical outcomes.</p><p><strong>Methods: </strong>A scoping review was conducted according to the PRISMA-ScR guidelines. PubMed, Embase, and CINAHL were searched for articles published before January 1st, 2026. Eligible studies described meetings involving surgical or oncological healthcare professionals (HCPs) from ≥3 centers, with comparison of hospital data, and discussion of inter-hospital variation in outcomes. Reviews were excluded.</p><p><strong>Results: </strong>A total of 2,208 articles were identified through the search, of which 27 were included. Two articles described the structure of BPMs. The remaining articles reported formulated best practices or evaluated the effect on clinical outcomes. Positive trends were observed in clinical processes (83.3%), morbidity (29.2%), and/or mortality rates (8.3%). A statistically significant improvement in at least one quality indicator following BPMs, either alone or within broader QI initiatives, was observed in 87.5% of the included outcome studies. Patient and participant experience had a high satisfaction rate. In 8 out of 27 articles, data were compared with a control group, and in 14 out of 27 articles, no control group was included.</p><p><strong>Conclusions: </strong>Most included articles reported predominantly positive effects following BPMs. However, the level of evidence is low (Level 4) due to risk of bias and the study designs of the articles; the majority were uncontrolled time-series, making them susceptible to secular trends. In the future, high-quality studies, e.g., with a stepped-wedge design, are needed to establish a causal relationship between BPMs and improved clinical outcomes.</p>","PeriodicalId":17542,"journal":{"name":"Journal of thoracic disease","volume":"18 3","pages":"247"},"PeriodicalIF":1.9,"publicationDate":"2026-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13077351/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147690892","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The geriatric nutritional risk index predicts pathological complete response and anastomotic leakage in esophageal cancer patients undergoing neoadjuvant therapy.","authors":"Jingyuan Niu, Jiahao Huang, Min Zhang, Bin Yang, Tao Lu","doi":"10.21037/jtd-2025-aw-2365","DOIUrl":"https://doi.org/10.21037/jtd-2025-aw-2365","url":null,"abstract":"<p><strong>Background: </strong>Esophageal squamous cell carcinoma (ESCC) poses a significant global health challenge. Pathological complete response (pCR) to neoadjuvant therapy followed by surgery is a crucial predictor of survival, but treatment response is highly variable. Nutritional status and systemic inflammation are key determinants of outcomes. This study aimed to evaluate the geriatric nutritional risk index (GNRI), alone and combined with body mass index (BMI), as a predictor for pCR and anastomotic leak (AL) in this patient population.</p><p><strong>Methods: </strong>In this retrospective study, 143 ESCC patients undergoing neoadjuvant therapy and radical esophagectomy were enrolled. The GNRI was calculated using serum albumin and body weight. The optimal GNRI cutoff for predicting pCR was determined by receiver operating characteristic (ROC) curve analysis. Patients were stratified into high (≥106.7) and low (<106.7) GNRI groups. Univariate and multivariate logistic regression analyses were performed to identify independent predictors for pCR and AL. The synergistic value of GNRI and BMI was assessed through collinearity analysis, mutual adjustment in multivariate models, and model fit statistics [Akaike information criterion (AIC), likelihood ratio tests].</p><p><strong>Results: </strong>The pCR rate was significantly higher in the high GNRI group (39.3% <i>vs.</i> 10.2%, P<0.001). GNRI demonstrated good predictive accuracy for pCR [area under the curve (AUC) =0.706] with high sensitivity (87.2%). Multivariate analysis confirmed high GNRI as an independent predictor for pCR [odds ratio (OR)=3.90] and a protective factor against AL (OR =0.39). The AL rate was significantly lower in the high GNRI group (16.67% <i>vs.</i> 33.90%, P=0.02). Despite a strong correlation between BMI and GNRI (R=0.76, P<0.001), both retained independent predictive value for pCR after mutual adjustment. A combined model (GNRI + BMI + confounders) yielded the best fit (lowest AIC=139.8) and the highest discriminative ability (AUC=0.873).</p><p><strong>Conclusions: </strong>Pretreatment GNRI is a powerful, independent predictor for pCR and AL in ESCC patients. Its high negative predictive value helps identify patients with a very low probability of responding to standard neoadjuvant therapy. The combination of GNRI and BMI provides superior predictive power for pCR, as they offer complementary information. These simple, cost-effective indices should be integrated into initial patient assessment to improve risk stratification and guide personalized treatment strategies.</p>","PeriodicalId":17542,"journal":{"name":"Journal of thoracic disease","volume":"18 3","pages":"185"},"PeriodicalIF":1.9,"publicationDate":"2026-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13077359/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147690908","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}